Urticarial Vasculitis Associated With Levothyroxine.

Urticarial vasculitis (UV) is a protean disorder that can be triggered by a myriad of causes although it is often idiopathic. Treatment is often successful with corticosteroids and/or immunosuppressive drugs. However, when a cause is found, specific treatment of the underlying problem or removal of an offending agent will resolve the symptoms. This report describes a patient with UV triggered by thyroid replacement, necessitated by Hashimoto's thyroiditis, which can itself cause UV. In this unusual presentation, rather than thyroiditis, thyroid replacement was the trigger for the vasculitis.

Longitudinal Analysis of Patient-Reported Cognitive Function in Multiple Myeloma.

BACKGROUND: Cancer-related cognitive impairment (CRCI) has been largely unstudied in patients with multiple myeloma (MM). This study describes patient-reported cognition over time and patient factors associated with adverse cognitive outcomes in MM. METHODS: Participants enrolled in a registry in which they completed a geriatric assessment at study entry, and 3 & 6 months after entry. Cognitive function was assessed using the EORTC QLQ-C30 Cognitive Function subscale, with CRCI defined as scores < 75. Generalized estimating equation (GEE) models were used to fit longitudinal models to investigate differences by group and differences in changes over time by group, with adjustment for time since diagnosis. RESULTS: One hundred and four adults with MM had mean age of 67 years and 30% identified as Black. Patient-reported CRCI was present in 18% of participants at enrollment, 21% at 3 months, and 30% at 6 months. Worse cognitive function was reported in those with impairments in physical function (P = .002), IADLs (P = .02), and performance status (P = .04), as well as in those who were prefrail/frail (P = .02) and depressed (P = .049). Greater cognitive decline over time was observed in patients without CRCI at enrollment (P < .0001) and those with lower levels of education (P = .04). CONCLUSION: This is one of the first studies to describe longitudinal changes in patient-reported cognition in patients with MM. Several potentially intervenable factors, including physical function impairment and depression, were associated with worse cognition at study entry, but only baseline CRCI status and education level were predictive of future decline.